Obesity adversely affects outcomes in patients who underwent minimally invasive hysterectomy for benign indications, according to a study presented at the annual meeting of the American Association of Gynecologic Laparoscopists (Abstract 5616) and simultaneously published in the Journal of Minimally Invasive Gynecology. Obesity prolongs operating room time and also increases blood loss during the surgery.

The retrospective study included 2494 women who had a minimally invasive hysterectomy done for benign indications between 2013 and 2019. Their mean age was 48 years, while the mean body mass index (BMI) was 30.

The objective of the study was to examine the impact of obesity on clinical outcomes as measured by the operating room (OR) time, estimated blood loss, duration of hospitalization, adverse perioperative events (such as blood transfusions, organ injury, conversion to open surgery, re-hospitalization within a month, emergency visits) as well as procedure costs. Patients were categorized as per their BMI and the surgical approach. Non-obesity was defined as BMI <30, 30-39 as obese and BMI >40 as Class III obese.

Hysterectomy was most commonly performed by laparoscopic approach (78.5%). Nearly 14% underwent robotic surgery, while 8% had vaginal hysterectomy. The total cost for the surgery was $13,928 (mean).

The OR time was longer and the estimated blood loss was higher among obese patients (BMI 30-39), while class III obese patients (BMI > 40) experienced the longest OR time and the highest EBL.

When the different surgical approaches were analyzed, class III obese patients who underwent laparoscopy had a 37-minute increase in OR time and those who underwent vaginal hysterectomy had a 199.2 mL increase in blood loss compared with normal weight patients. The OR time was 220 minutes in the class III obese patients and the blood loss was 475 mL. No effect of obesity on duration of hospitalization or occurrence of adverse perioperative events was observed. While class III obesity was significantly associated with increased costs, laparoscopic hysterectomy was associated with lower costs by $702 in obese patients compared to non-obese patients.

This study has demonstrated that the surgical approach adopted for the minimally invasive hysterectomy considerably influences clinical outcomes as well as surgery costs. This was most evident in the morbidly obese patients i.e., women with BMI more than 40. They had longer surgeries and higher blood loss. Obese patients therefore should be counseled about weight management before the surgery for optimal outcomes.

Reference

1. Le Neveu M, et al. Impact of body mass index on clinical and financial outcomes of benign minimally invasive hysterectomy. Journal of Minimally Invasive Gynecology. 2021;28:S111.